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Date of last update: 8/24/2017.

Forum Name: Psychiatric Topics

Question: Treatment resistant depression: 10yrs, what options?

 mtlmusic - Fri Jul 30, 2010 7:46 am

I'm 28 now and have had depression (with associated anxiety) for almost ten years. I was diagnosed only one year after symptoms presented themselves and have since seen over a dozen doctors and psychiatrists in this time. The consensus seems to be "depression" and they have all insisted that it's easily treated and will go away.

Basically it seems to cycle in four 3-6 month periods independently of season, diet, exercise, social engagement/activity/(even stressors to an extent), and economic circumstance. No one has seen the better periods as hypo-mania.

1.) suddenly appearing classic depressive symptoms later resulting in anxiety issues (including some social phobia and panic attacks)
2.) receding symptoms (after removing virtually every stressor in my life and change in meds)
3.) resolution of symptoms and great levels of energy and desire to make-up for lost time; a real feeling that anything is possible and that the immediately preceding inabilities couldn't have been real, but a construct of my psyche.
4.) as "normal" a feeling as I remember life being before all of this.

That said, I am unable to finish single semesters of part-time school. I require flexible, easy-going and supportive employment environment. I have a hard time relating to people closely for having been so removed from normal functionality.

Do you have ANY ideas?

Thank you for your time.
 Faye Lang, RN, MSW - Fri Jul 30, 2010 10:26 pm

Hello mtlmusic,

Your description of your age of onset and the cyclic symptoms appear to fit a diagnosis called "Cyclothymic Mood Disorder", which is essentially a milder form of Bipolar Disorder. It tends to run in families and may involve changes in brain chemistry and/or environmental influences. It begins in adolescence or young adulthood. It has been thought to be relatively rare, but in fact may be underreported since it can easily be diagnosed as other mood disorders or depression.

Cyclothymia is a chronic mood disorder that results in emotional ups and downs that are less extreme or severe than Bipolar Disorder. The symptoms are very similar, but don't "qualify" as mania, hypomania, or Major Depression. The person usually can still function. Mood shifts occur which disrupt the person's life, since the shifts are unpredictable and can't be controlled by willpower alone. The hypomanic phase of Cyclothymic Disorder can include euphoria, elevated optimism, high self-esteem, poor judgment, rapid speech, some racing thoughts, aggressiveness or hostile behavior, spending sprees, taking risks, distractability, inability to concentrate, and less need for sleep. The depressive phase can include sadness, feelings of hopelessness, thoughts of self-harm, anxiety, feelings of guilt, sleep problems, changes in appetite, loss of interest in usual activities, irritability, and unusual chronic pain.

Treatment consists of anti-depressant medication, possible adjunct anti-anxiety medication or low-dose anti-psychotic medication during the hypomanic phase, individual therapy and psychiatric monitoring. The condition may be lifelong and require ongoing treatment, particularly medication.

I realize that while it may be encouraging to learn of a condition that sounds very much like what you are experiencing, it can be very disappointing to learn that it is a long-term, chronic condition. It is manageable with medication and therapy, so it is not a hopeless situation. The goal is adequate functional ability without the mood swings, and successful treatment requires adherence to both therapy and prescribed medications.

I hope this information is helpful to you, and I wish you good luck.

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